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Ankle and Ligaments

Ankle Sprain

A Patient's Guide

Ankle sprains are one of the most common musculoskeletal injuries, particularly among athletes and physically active individuals. These injuries occur when the ligaments that support the ankle stretch beyond their limits or tear. Ligaments are tough, fibrous tissues that connect bones and provide stability to joints. Ankle sprains can range from mild to severe, depending on the extent of the ligament damage. Understanding the symptoms, appropriate investigations, and treatment options is crucial for effective management and recovery.

Symptoms and Signs

Recognising the symptoms and signs of an ankle sprain is essential for timely and appropriate treatment. The severity of these can vary depending on the grade of the sprain:

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  • Grade I (Mild): Involves slight stretching and microscopic tearing of the ligament fibres. Symptoms include mild pain, swelling, and tenderness around the ankle. The joint remains stable, and weight-bearing is generally possible with minimal discomfort.

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  • Grade II (Moderate): Involves partial tearing of the ligament. Symptoms include moderate pain, swelling, and bruising. There is noticeable tenderness around the injury site, and walking is difficult due to pain and instability in the ankle.

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  • Grade III (Severe): Involves a complete tear of the ligament. Symptoms include severe pain, significant swelling, and extensive bruising. The ankle joint is unstable, and bearing weight is usually impossible without significant pain.

Image by Rémi Jacquaint
Leg Injury

Assessment

Proper diagnosis of an ankle sprain involves a thorough clinical evaluation and, in some cases, imaging studies to assess the extent of the injury.​

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Clinical Evaluation

  • History: You will be asked about the injury mechanism, onset of symptoms, and any previous ankle injuries.

  • Physical Examination: This includes inspecting the ankle for swelling, bruising, and deformity. Palpating the ankle will identify points of tenderness and  specific manoeuvres to assess ligament integrity and joint stability.

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Imaging Studies

  • X-rays: Often used to rule out fractures, which can present with similar symptoms to sprains. X-rays can also help identify avulsion fractures where a ligament pulls off a piece of bone.

  • MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, including ligaments and tendons. MRI is particularly useful for assessing the severity of ligament tears and identifying associated injuries such as cartilage damage.

  • Ultrasound: Can be used to visualise ligament injuries and assess dynamic stability during movement. It's a useful tool for diagnosing tears and other soft tissue abnormalities when MRI is not tolerated.

Acute Treatment

Treatment for an ankle sprain aims to reduce pain and swelling, promote healing, and restore function. The approach varies depending on the severity of the sprain.

  • R.I.C.E Protocol:

    • Rest: Avoid weight-bearing activities to prevent further injury. Using crutches can help keep weight off the injured ankle.

    • Ice: Apply ice packs for 15-20 minutes every 2-3 hours during the first 48-72 hours post-injury to reduce swelling and numb pain.

    • Compression: Use an elastic bandage or ankle brace to compress the area and limit swelling. Ensure the bandage is snug but not so tight that it restricts blood flow.

    • Elevation: Keep the ankle elevated above heart level as much as possible to reduce swelling.

  • Medications:

    • Analgesics: Over-the-counter pain relievers can help manage pain and rarely, prescription medications may be necessary for more severe pain.

  • Protection:

    • Immobilisation: For more severe sprains, a short period of immobilisation using a splint, boot or cast may be recommended to allow proper healing. The period of immobilisation will be dependent upon clinical and radiological findings.

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Image by Andreea Boncota

Advanced Treatment

Moderate to severe sprains are likely to need advanced treatment of physiotherapy and possibly surgery. 

  • Physiotherapy:

    • Mobility: Once the initial pain and swelling subside, gentle range-of-motion exercises should be started to prevent stiffness.

    • Strengthening: Focus on the muscles around the ankle to support the joint and prevent future injuries. Exercises may include calf raises, ankle circles, and resistance band exercises.

    • Proprioception: Balance exercises help improve coordination and reduce the risk of recurrent sprains. Activities such as standing on one leg or using a balance board are commonly used.​​

  • ​Surgery:

    • Ligament repair and reconstruction: Surgery may be considered when there is a complete tear of the ligament, and the ankle remains unstable despite conservative treatment. Surgical options include Broström-Gould ligament repair or allograft reconstruction.​

Summary

Ankle sprains, though common, should not be underestimated due to their potential to cause significant discomfort and functional impairment. The majority of ankle arthritis cases seen in the older population will stem from ligament damage in a patient's younger years. Early recognition of symptoms, appropriate diagnostic investigations, and a tailored treatment plan are essential for optimal recovery. Following a structured rehabilitation program not only ensures proper healing but also helps prevent future injuries. If you suspect an ankle sprain, seeking prompt medical advice from an experienced ankle surgeon such as Shelain Patel could make a significant difference in the outcome and speed of recovery.

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